Menopause Matters: Osteoporosis & Vitamin D

Summer is just around the corner and the time of the year we spend with family & friends at backyard BBQ’s, pool parties, and the beach. A great time to renew friendships and get away, but too much of a good thing may be harmful, like sunlight. Your PCP and dermatologist are going to remind you about the importance of using sunscreen to protect you from UV rays which can cause skin cancer. Sunlight is where we get most of our vitamin D, what to do? I will use the next several columns to review bone health, vitamin D and calcium, osteoporosis, and bone scans. Today with start with vitamin D.

The following is from physician database called UpToDate which has a limited amount of basic free information for patients.

Sunlight is essential for synthesis of vitamin D and has beneficial effects on mood. However, ultraviolet (UV) radiation (290 to 400 nm) is responsible for several acute and chronic detrimental effects on human skin, including sunburn, photoaging, and skin cancer.

UVB (290 to 320 nm), which represents only 5 percent of the UV reaching the earth surface, includes the biologically most active wavelengths. UVB is responsible for sunburn, inflammation, hyperpigmentation, and photocarcinogenesis.

Approximately 95 percent of the UV radiation reaching the earth surface is UVA (320 to 400 nm). UVA has a major role in photoaging and pigment darkening and may be involved in skin carcinogenesis [1-3].

Photoprotection, which includes sun avoidance during peak hours, sun-protective clothing, and sunscreens, is crucial to prevent or reduce the potential harms associated with UV exposure.

The following are excerpts from U.S. Preventative Services Task Force Recommendation Statement: Screening for Vitamin D & NIH consensus about Vitamin D and Primary Care Practice 2015.

There is widespread agreement that vitamin D promotes bone health and, together with calcium helps protect older adults from bone loss. It is generally felt that most persons get their vitamin D from sun exposed skin. Also, there appears to be a benefit from vitamin D supplementation to prevent falls in the frail elderly who are at risk for vitamin D deficiency. Whether vitamin D supplementation offers the same benefit in healthy, well-nourished older individuals is unclear. Beyond bone health and possible fall prevention, research during the last 15 years has suggested that normal vitamin D levels might provide other benefits including reduced risk for cardiovascular disease, cancer, diabetes, autoimmune diseases and infectious respiratory diseases. Most of the research thus far have been in observational trials with final results years away. Some contend that promoting vitamin D even in the absence of data from clinical trials is good for the public health. This logic is flawed given that prior enthusiasm for high dose nutritional therapies based on observational studies like vitamin E, beta-carotene, and selenium waned when clinical trials demonstrated not only lack of benefit, but potential harm. At annual well woman exams, my patients share their list of OTC vitamins and the recommended amounts by Consumers Reports, Dr. Oz or Good Morning America’s health expert so it must be safe?

What do Serum measures tell us about Vitamin D status according the IOM and professional societies?

Serum concentration of 25-hydroxyvitamin D (25-HD) is the best indicator of vitamin D status. The Institute of Medicine (IOM) concluded that 20 ng/ml serum 25-HD is the level considered normal in almost all (97%) of the general population. The Endocrine Society agreed with the IOM except in frail elderly adults, pregnant women, and dark skinned individual for whom they recommend 30 ng/ml. If your vitamin D level is around or above 20 ng/ml, you are fine and don’t need to take any supplement. Levels below 20 ng/ml can be treated with 600- 800 IU vitamin D daily but don’t require follow-up testing. Taking doses of vitamin D over 800 units/d may prove to be harmful in the future so be careful.

Next month on July 13 from 6-7 pm I will be having informal evening program with light appetizers where my patients will share their experience after MonaLisa Touch (MLT). MonaLisa Touch is an FDA approved laser that restores genitourinary health for pre and postmenopausal women. Tens of thousands of women have been treated worldwide and are turning back the clock. If you are interested in attending, please call the office (925) 935-6952. More information at our website and Facebook page TimothyLeachMD.

Dr. Timothy Leach

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